Angioplasty uses imaging guidance to insert a balloon-tipped catheter into a narrow or blocked blood vessel where the balloon is inflated to open the vessel and improve blood flow. It may be done with vascular stenting – the placement of a small wire mesh tube within the blood vessel to help keep it open. The procedure is much less invasive than other surgical interventions and usually does not require general anesthesia.
3. Definition
angioplasty, with or without vascular
stenting, is a minimally invasive
procedure performed to improve blood
flow in the body's arteries and veins and
is usually performed in an interventional
radiology suite
4. Indications
1. Narrowing of large arteries (aorta and its branches) due
to atherosclerosis , or hardening other arteries, a gradual
process in which cholesterol and other fatty deposits, called
plaques, build up on the artery walls.
2. Peripheral artery disease (PAD), a narrowing of the
arteries in the legs or arms. In patients with PAD,
angioplasty alone or angioplasty with stenting may be used
to open up a blocked artery in the pelvis, leg or arm.
5. 3. Renal vascular hypertension, high blood
pressure caused by a narrowing of the kidney
arteries. Angioplasty with stenting is a commonly
used method to open one or both of the arteries that
supply blood to the kidneys. Treating renal arterial
narrowing is also performed in some patients to
protect or improve the kidney function.
4. Carotid artery stenosis , a narrowing of the neck
arteries supplying blood to the brain.
5. Coronary artery disease, a narrowing of the
coronary arteries that carry blood and oxygen to the
heart muscle.
6. 6.Venous narrowing involving the central veins (in
the chest, abdomen or pelvis). In some cases,
stenting of the narrowed vein is also needed.
7. Narrowing in dialysis fistula or grafts. When
there is decreased flow in the graft or fistula making
it inadequate for dialysis, angioplasty is generally
the first line of treatment. Stenting or stent grafting
may also be needed in some case
8. Before a bypass surgery.
7. Contraindications
• Allergy to contrast (dye) medium
• Uncontrolled Blood Pressure (Hypertension)
• Problems with blood coagulation (Coagulopathy)
• Kidney failure or dysfunction
• Severe anemia
• Electrolyte imbalance
• Fever
• Active systemic infection
• Uncontrolled rhythm disturbances (arrhythmias)
• Uncompensated heart failure
• Transient Ischemic attack
10. C-arm
It can be unipolar or bipolar
Bipolar (lateral , frontal ) Carm used to produce two
angiograph at two angle at same time , reducing time and
contrast media .
14. Sheath:
is a plastic tube with a tap on one end. It usually
measures 2–3 mm (1/8 inch) in diameter. Once
the sheath is in place, the balloons and stents are
all passed through this sheath.
Wire:
used to provides extra strength and stability
during catheter placement .
Used two type stiff for chronic condition and floppy
for acute condition
15.
16. Catheter :
medical devices that can be inserted in the body to treat
diseases or perform a surgical procedure
◦ There is a two types of catheter: (diagnostic and
therapeutic)
17.
18. Stent:
A stent is a small mesh tube that's used to treat narrow or weak
arteries. A stent is placed in an artery as part of a procedure
called percutaneous coronary intervention (PCI), also known
as coronary angioplasty. PCI restores blood flow through
narrow or blocked arteries. A stent helps support the inner
wall of the artery in the months or years after PCI.
There are two type of stent: drugeluting and bare metal The
amount of restenosis at drugluting is less than bare
metal because it has a drugs inside it avoid restenosis and
active as healing material .
19.
20. Balloon:
Interventional cardiologists perform angioplasty,
which opens narrowed arteries. They use a long,
thin tube called a catheter that has a small balloon
on its tip. They inflate the balloon at the blockage
site in the artery to flatten or compress the plaque
against the artery wall. Angioplasty is also called
percutaneous transluminal coronary angioplasty
(PTCA).
◦ Tow type of balloon compliance and non-
compliance
23. Patient preparation
◦ Patients may be required to be admitted to the hospital the
night before the procedure. For some patients, overnight
stay is not required.
(Nil per oral [NPO] or nothing to eat or drink by mouth 6-8
hours before the test.)
◦ The cardiologist will explain the procedure and risks
associated with it.
• Consent form should be signed before the procedure.
• Any questions or doubts should be asked and clarified
with the doctor before surgery.
24. ◦ The doctor should be informed of allergies to
medications, iodine or food. It should also be
documented legibly in the patient’s chart.
• Previous allergic reactions to contrast dyes must be
mentioned.
◦ Catheterization procedure requires X-
ray fluoroscopy. Women patients in childbearing
age can undergo pregnancy test to rule
out pregnancy.
25. ◦ Medications that are taken on the day of cardiac
catheterization should be discussed with the doctor.
Some medicines taken for blood thinning
(e.g., Aspirin), erectile dysfunction (Sildenafil or
Tadalafil) or diabetic medication (metformin) needs
to be stopped on the day or few days before the
procedure.
• Kidney disease should be assessed before, as
contrast materials or dyes may not be used in
patients with abnormal kidney function.
◦ Some blood tests and electrocardiogram (ECG) will
be performed before the procedure.
26. • A mild sedative will be given orally or
intravenously to comfort the patient and
relieve anxiety.
• All personal belongings and jewelry will be
removed and patient will be dressed in a
hospital gown before being transported to the
catheterization laboratory.
27. Protection
◦ lead apron of .5 mm lead equivalent is worn during the
procedure .
◦ lead glass radiation shielding is used
28. Procedure
◦ A nurse or technologist will insert an intravenous (IV) line
into a small vein in your hand or arm.
◦ A small amount of blood will be drawn before starting the
procedure to make sure that your kidneys are working and
that your blood will clot normally. A small dose of sedative
may be given through the IV line to lessen your anxiety
during the procedure.
◦ The area of the groin or arm where the catheter will be
inserted is shaved, cleaned, and numbed with local
anesthetic
29. ◦ The radiologist will make a small incision (usually a few
millimeters) in the skin where the catheter can be inserted
into an artery
◦ Your surgeon will be able to see your artery with live x-ray
pictures. Dye will be injected into your body to show blood
flow through your arteries. The dye will make it easier to
see the blocked area.
◦ Your surgeon will guide a thin tube called a catheter
through your artery to the blocked area.
◦ Next, your surgeon will pass a guide wire through the
catheter to the blockage.
◦ The surgeon will push another catheter with a very small
balloon on the end over the guide wire and into the
blocked area.
30. ◦ The balloon is then filled with contrast fluid to inflate
the balloon. This opens the blocked vessel and
restores blood flow to your heart.
◦ A stent may also be placed in the blocked area. The
stent is inserted at the same time as the balloon
catheter. It expands when the balloon is blown up.
The stent is left in place to help keep the artery open.
The balloon and all the wires are then removed.
31. Access to coronary artery:
Radial artery Brachial Axillary
Subclavian Ascending aorta Coronary artery
The other access is femoral artery: its rare entrance and for
patient with renal disease
32. Risk
◦ Allergic reaction to the drug used in a stent that releases
medicine into your body
◦ Allergic reaction to the x-ray dye
◦ Bleeding or clotting in the area where the catheter was
inserted
◦ Blood clotting in the legs or the lungs
◦ Damage to a blood vessel
◦ Damage to a nerve, which could cause pain or numbness
in the leg
33. ◦ Damage to the artery in the groin, which may
need urgent surgery
◦ Heart attack
◦ Infection in the surgical cut
◦ Kidney falier (higher risk in people who already
have kidney problems)
◦ Misplacement of the stent
◦ Stork (this is rare)
